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PubMed1990

[Venous digital subtraction angiography of the left ventricle in comparison with conventional angiography].

In 42 patients with coronary heart disease within a left heart catheterization by means of coronarography and conventional angiocardiography in each case before and after GTN digital subtraction angiographies of the left ventricle were performed with central venous injection of 20 ml visotrast with a flow of 16-18 ml/s. A DVI2-CV system of the firm Philips served as investigation device. In general between the angiocardiography and the digital subtraction angiographies the following results were obtained for EF 0.81, EDV 0.71, and ESV 0.88. When evaluating only the finally examined 22 patients the correlations improve for all parameters (EF: 0.89, EDV: 0.82, ESV: 0.90). Furthermore is was shown that the volumes are underestimated by 8-10%. The quantification of the regional movement of the wall according to the radial axis method did not results in any significant differences between the digital subtraction angiographies and the angiocardiography. The effects of GTN on the global and regional functional parameters appear somewhat more distinct in the digital subtraction angiographies than in the angiocardiography and are partly significant only in the first one. The influence of the experience of the investigator, the cardial state of the patient and other influential factors on the quality of the digital subtraction angiocardiographies are described and discussed. Therefore we regard the digital subtraction angiography as method of choice in indications to right heart catheterization without coronary angiography.

Adult↗

PubMed1998

[Detection of aneurysm in subarachnoid hemorrhage--CT angiography vs. digital subtraction angiography].

PURPOSE: The value of CT-angiography (CT-A) for the visualization of intracranial aneurysms was more closely defined by comparison with digital subtraction angiography (DSA). METHODS: Over a period of 18 months a total of 106 patients in whom a subarachnoidal hemorrhage had been detected on native CT were examined in parallel by spiral CT and DSA. CT-angiography was performed under standardized parameters and included processing with 3D surface reconstructions. RESULTS: In 64 patients (60.4%) a total of 72 aneurysms were detected. In four cases (6.2%) there were two and in two cases (3.1%) even three aneurysms. The findings of DSA and CTA agreed in 98 cases (92.5%). In four patients (3.8%) a false negative result was obtained in CTA and the initial DSA. CONCLUSIONS: Digital subtraction angiography must still be considered as the gold standard in the diagnosis of cerebral aneurysms. On account of its excellent spatial delineation of aneurysms and possibilities for exact measurements, CT-angiography represents a valuable, supplementary method--in some cases also an alternative method--to digital subtraction angiography.

Adult↗

PubMed2005

Multislice spiral computed tomographic angiography of coronary arteries in patients with suspected coronary artery disease: an effective filter before catheter angiography?

BACKGROUND: Despite impressive image quality, it is unclear if noninvasive coronary angiography with multislice spiral computed tomography (CT) is powerful enough to act as a filter before invasive angiography (INV-A) in symptomatic patients. METHODS AND RESULTS: We therefore studied 133 consecutive symptomatic patients with suspected coronary artery disease (CAD) and an indication for INV-A (chest pain and signs of ischemia in conventional stress tests). Patients with known CAD, acute coronary syndrome, or a calcium volume score >1000 were excluded. In all patients, both INV-A and multislice CT angiography (MSCT-A) (Philips MX 8000 multislice spiral CT, scan time 250 milliseconds, slice thickness 1.3 mm, 120 mL of contrast agent, 4 mL/s, retrospective gating) were directly compared by 2 independent investigators using the American Heart Association 15-segment model. Altogether, we studied 1596 segments, 74% had diagnostic image quality. Multislice CT angiography correctly identified 68 significant stenoses of the 75 stenoses seen with INV-A (sensitivity 91%). In 945 of 1185 diagnostic segments, stenosis could correctly be ruled out with MSCT-A. There were 3 times more stenoses seen with MSCT-A compared with INV-A (positive predictive value 29%) mainly because of misclassification of nonobstructive plaques as stenosis. The per-patient analysis allowed to exclude significant CAD in 42 (32%) of 133 patients. In only 6 of 53 patients, MSCT-A failed to detect significant stenosis, 4 of those were in small segments not requiring intervention. Calcium scoring alone was less suited as a filter before angiography: 25 patients (18% of study group) had a calcium score = 0, and 8 of these patients turned out to have significant stenoses. CONCLUSION: Multislice CT angiography, but not calcium scoring alone, offers promise to reduce the number of INV-A in symptomatic patients with suspected CAD by up to one third with minimal risk for the patient.

Aged↗

PubMed1993

Carotid bifurcation imaging: magnetic resonance angiography compared to conventional angiography and Doppler ultrasound.

PURPOSE: to evaluate the clinical usefulness of the two dimensional "Time of Flight" (2D TOF) Magnetic Resonance Angiography technique (MRA) in imaging the carotid bifurcation as compared to conventional angiography and pulsed and colour Doppler ultrasound. METHODS: in 19 patients with possible cerebrovascular disease and eight volunteers, contrast angiography was compared with MRA in 21 carotid bifurcations and with Doppler ultrasound in 23 bifurcations by two independent observers. In 19 bifurcations, all three techniques were available for comparison. Internal carotid arteries were graded normal/minimal disease, mild, moderate or severe stenosis, or occluded. RESULTS: overall agreement between contrast angiography and MRA existed in 62% for one observer and 76% for the other. When MRA and Doppler agreed, agreement between these two investigations and contrast angiography existed in 77-81%. The major problem with MRA was overestimation of moderately stenosed vessels; 50% of the vessels with a moderate stenosis on contrast angiography were judged severely stenosed on MRA. An occlusion was never mistaken for a stenosis by MRA. Evaluating the separate slices, acquired in the 2D TOF MRA investigation, appeared to be essential to avoid this mistake. CONCLUSION: at present 2D TOF MRA is not clinically useful for diagnosing the degree of carotid artery stenosis. MRA has a clear tendency to overestimate the degree of stenosis especially moderately severe stenoses. To date, there are no objective methods to correct for this mistake. Technical improvements may make MRA a better diagnostic tool in the future.

Adolescent↗

PubMed1997

Indocyanine green angiography in central serous chorioretinopathy. ICG angiography in CSC.

PURPOSE: To analyse images obtained by indocyanine green angiography in central serous chorioretinopathy (CSC). METHODS: Ninety patients affected with CSC were examined using indocyanine green angiography. RESULTS: CSC was detected in 127 of the 180 eyes examined. Leakage points were detected in 99 eyes with fluorescein angiography; in 85 of these eyes, they corresponded to hyperfluorescence with indocyanine green angiography, while a hyperfluorescence of the neuroepithelial detachment was seen in 21 eyes. Areas of choroidal hyperpermeability were seen in all 127 eyes with CSC and in 9 fellow eyes. With ICG angiography, the appearance of pigment epithelial detachments was similar to that previously described (early hyperfluorescence and later hypofluorescence), and was seen in 47 eyes. In 103 eyes, hypofluorescent lesions of various sizes, were detected which became more marked in the later stages. These lesions corresponded to retinal pigment epithelium lesions in fluorescein angiography, mainly hyperfluorescence caused by window defect. We were also able to observe RPE atrophic tracts in 31 eyes. These tracts appeared hyperfluorescent in 11 eyes where a minimal amount of RPE atrophy was present and hypofluorescent in 20 eyes in which the tract had marked RPE atrophy. CONCLUSION: The results obtained confirm the finding of choroidal hyperpermeability and subretinal diffusion of ICG, which indicate involvement of the choroid in CSC. The observation of progressively hypofluorescent lesions corresponding to retinal pigment epithelium alterations suggests that there may be as yet unknown interactions of pigment epithelium and ICG.

Adult↗

PubMed2004

Aortoiliac angiography during coronary artery angiography detects significant occult aortoiliac and renal artery atherosclerosis in patients with coronary atherosclerosis.

PURPOSE: Peripheral atherosclerosis (renal and aortoiliac localizations) are frequently detected in aged patients with concomitant coronary artery disease (CAD): the risk of finding peripheral disease is increased in patients with CAD. Angiography of the aortoiliac vessels performed at the time of coronary angiography may detect any occult renal artery stenosis and atherosclerotic involvement of the aortoiliac segment. We sought to determine utility of performing angiography of aortoiliac and renal arteries during coronary arteriography in patients with known or suspect coronary atherosclerosis. METHODS: Medical records of all patients undergoing combined coronary and aortoiliac angiography between May 1998 and December 2002 was retrospectively reviewed. Moderate to severe arterial stenosis (>50% stenosis), vessel occlusion, aneurismal vessels were noted as significant angiographic findings. Contrast-induced nephropathy was defined as a rise in serum creatinine of > or =25% form baseline. RESULTS: In the study period 112 patients (81 males, mean age 68.4+/-7.8 years) with known or suspected CAD underwent combined cardiac catheterization and aortoiliac angiography. Pretreatment with 0.45% saline at a rate of 1 ml/kg/h for 12 h was administered to all patients. Significant findings were reported in 37 (33%) patients including 14 renal artery stenoses, 8 aortic aneurismal disease, and 15 aortoiliac lesions. Most patients with significant findings had 2 and 3-vessel CAD. A strong correlation was found between the number of risk factors and the frequency of angiographic findings (r = 0.92). Complications include six contrast-induced nephropathy: no case required renal replacement therapy. CONCLUSIONS: Aortoiliac and renal atherosclerosis is frequently associated to multivessel CAD. In selected patients undergoing cardiac catheterization aortoiliac angiography may be practical in detecting occult renal or aortoiliac artery lesions. Further clinical outcome studies are strongly required to support this strategy.

Aged↗

PubMed1996

[The accuracy of angiography and CT angiography of the carotid bifurcation compared to macro-morphological correlation].

PURPOSE: To compare the degree of carotid artery stenosis in angiography and CT angiography with the degree of stenosis measured in an intact eversion endarterectomy specimen. METHODS: Preoperative angiograms (intraarterial DSA, 512 x 512 matrix) and CT-angiograms (24 sec spiral scan, slice thickness 2 mm, pitch 1.5) were taken in 12 patients with symptomatic carotid stenosis. Evaluation of the degree of stenosis was performed according to the NASCET ("distal" degree) and ECST ("local" degree) methods. These data were compared with measurements of the surgical specimens. RESULTS: The median "local" degree of stenosis in angiograms was 81.5% (range: 70-99%), in CT angiograms 83% (59-94%) and in specimens 85.5% (65-96%). The "distal" degree of stenosis was 79% (50-99%) in angiograms, 85.5% (55-99%) in CT angiograms and 81% (52-95%) in specimens. CT angiography slightly overestimated the degree of stenosis compared with the specimen, whereas angiography slightly underestimated the true degree of stenosis. However, these differences were not statistically significant. CONCLUSION: CT angiography is able to predict the degree of internal carotid stenosis when compared with an intact surgical specimen. It is as accurate as the "gold standard" of invasive angiography.

Angiography, Digital Subtraction↗

PubMed1996

Variation in the use of coronary angiography in patients with unstable angina is related to differences in patient population and availability of angiography facilities, without affecting prognosis.

OBJECTIVES: Examination of the difference in management strategies with respect to coronary angiography in patients with unstable angina pectoris, and the consequences of this difference on prognosis. DESIGN: Prospective registration of consecutive patients admitted to two different hospitals. SETTING: University and a large community hospital in Rotterdam, the Netherlands. SUBJECTS: Patients under 80 years, without recent (< 4 weeks) infarction or recent (< 6 months) coronary revascularization procedure, admitted for chest pain suspected to indicate unstable angina pectoris. MAIN OUTCOME MEASURES: Decision to initiate coronary angiography or to continue on medical treatment. At 6 months the occurrence of death and myocardial infarction was measured. RESULTS: Clinical variables associated with the decision to initiate angiography were young age, male gender, progression of angina, multiple pain episodes and use of beta-blocker or calcium antagonists before admission, abnormal ST-T segment on baseline ECG, recurrent pain in hospital, and ECG changes during pain. These associations did not differ between hospitals. Nevertheless, angiography was performed more often in the presence of angiography facilities (university hospital), independent of the variable case-mix. Survival and infarct-free survival were similar in both hospitals, 96% and 90% respectively. CONCLUSION: The difference in angiography rate for unstable angina can be explained in part by differences in patient population and hospital facilities, but no difference was observed in physicians' assessment of patient characteristics. The observed practice variation did not affect prognosis.

Adult↗

PubMed2006

Renal arteries: comparison of steady-state free precession MR angiography and contrast-enhanced MR angiography.

All participants provided informed consent to participate in this study, which was approved by the institutional review board. Breath-hold three-dimensional (3D) steady-state free precession (SSFP) magnetic resonance (MR) angiography was compared with 3D contrast material-enhanced MR angiography in patients suspected of having renal artery stenosis. Two radiologists assessed visualization of renal arteries and detection of vascular disease. With SSFP MR angiography, 39 of 41 renal arteries in 19 patients were correctly detected. Relevant stenoses were correctly identified with SSFP MR angiography in two patients. In two patients, SSFP MR angiographic data sets led to false-positive overgrading of vascular disease. Fast breath-hold 3D SSFP MR angiography appears to be feasible for MR angiography of renal arteries.

Adolescent↗

PubMed2003

Multidetector CT angiography of peripheral vascular disease: a prospective comparison with intraarterial digital subtraction angiography.

OBJECTIVE: The purpose of this study was to determine the accuracy of CT angiography using a multidetector scanner in the evaluation of patients with peripheral vascular disease. SUBJECTS AND METHODS: Eighteen patients with peripheral vascular disease who were referred for elective digital subtraction angiography (DSA) also underwent CT angiography. We scanned patients from the level of the superior mesenteric artery to the pedal arteries in a single helical scan. CT angiograms were produced using maximum-intensity-projection reconstructions. Findings were graded according to six categories: 1, normal (0% stenosis); 2, mild (1-49% stenosis); 3, moderate (50-74% stenosis); 4, severe (75-99% stenosis); 5, occluded; and 6, nondiagnostic. CT angiography findings were compared with DSA findings for each arterial segment. RESULTS: We found agreement for the degree of stenosis in 77.7% of the arteries and discrepancy for 22.3% of the arteries when all categories were considered. Grouping the six categories according to the threshold for treatment (categories 1 and 2 as one group and categories 3, 4, and 5 as the second group) resulted in an agreement of 91.95%. Compared with DSA, CT angiography yielded a sensitivity of 90.9% and a specificity of 92.4%. CONCLUSION: Multidetector CT angiography is an accurate, noninvasive technique for the imaging of peripheral vascular disease.

Aged↗

PubMed2001

[Usefulness of transradial angiography and interventional angiography for abdominal diseases: comparison with transfemoral or transbrachial approach].

Transradial angiography has recently emerged as an alternative to the transfemoral or transbrachial approach, especially for coronary or cerebral procedures. However, there are few such studies regarding abdominal angiography. In our institution, we performed abdominal angiography and intervention by the transradial arterial method in 42 cases using a 120-cm-long 4 Fr catheter and compared the results with the transfemoral or transbrachial arterial method and examined the usefulness of this technique. Puncture was successfully carried out in 42 cases, whereas failure occurred in one case, in which the transbrachial method was adopted because of weak pulse. Selective catheter insertion was successful in all cases, after the shape of the catheter had been improved. No serious or dangerous complications occurred during the examinations. In addition, many patients chose the radial arterial method for subsequent examinations on a questionnaire survey we gave patients on the day after we did abdominal angiography by the transradial arterial method. We consider that the transradial arterial method can be used generally in angiography and interventional angiography for abdominal diseases.

Abdominal Neoplasms↗

PubMed1996

[Spiral CT angiography in the diagnosis of central pulmonary embolism: comparison with pulmonary angiography and scintigraphy].

PURPOSE: To evaluate the accuracy of spiral CT angiography in the diagnosis of central pulmonary embolism (PE). MATERIAL AND METHODS: A retrospective study was undertaken in a population of 90 patients who were evaluated with spiral CT angiography (acquisition: 12 to 24 s with or without strict apnea; injection of 90 cm3 of 12, 20 or 30% contrast material at a rate of 4 to 7 cm3, selective pulmonary angiography of each lung (n = 55) and/or ventilation-perfusion (VP) scanning (n = 35). RESULTS: Among the 55 patients evaluated with both spiral CT and angiography, central pulmonary embolism was excluded in 19 patients (34%), assessed in 29 patients (53%) whereas CT examination was considered as inconclusive in 7 patients (13%) due to interpretive difficulties at the level of obliquely oriented arteries and/or presence of hilar lymph nodes (sensitivity: 90.5%; specificity: 82.6%). With spiral CT, the finding of 95 central emboli (3 main, 61 lobar and 31 segmental) corresponded exactly to the angiographic findings; spiral CT enabled direct visualization of intraluminal filling defects (n = 95) whereas the angiographic recognition of PE was based on direct (n = 57) and indirect (n = 38) signs. Spiral CT angiography was more sensitive and specific than VP scanning. CONCLUSION: Spiral CT angiography appears as a sensitive and specific noninvasive method for the diagnosis of central PE.

Adolescent↗

PubMed1996

A prospective study of helical computed tomography angiography versus angiography for the detection of renal artery stenoses in hypertensive patients.

OBJECTIVE: To compare helical computed tomography angiography with arterial digital subtraction angiography in the diagnosis of renal artery stenoses. METHODS: Fifty hypertensives (24 men; mean age 53 years) were prospectively studied with computed tomography (Somaton Plus S, Siemens) and digital angiography (double-blind evaluation). Computed tomography was performed both in the sequential (the length of the abdomen) and in the helical (6 cm around renal arteries) modes during injection of 120 cm3 contrast medium. RESULTS: Digital angiography visualized 16 significant (< 50% on quantitative angiography) stenoses (16/131 renal arteries, including 32 accessory), in 14 (28%) patients. On helical computed tomography, 16 stenoses were detected, in 49 patients (16/122 renal arteries, seven accessory arteries were not identified because they were located out side the scan area); two patients had false-positive helical computed tomography results. The computed tomography sensitivity, specificity, positive and negative predictive values were 87.5% (14/16), 98.2% (111/114), 87.5% and 98.2%, respectively. In the sequential mode, two cases of bilateral adrenal hyperplasia, two aortic aneurysms and one renal neoplasm were detected. None of these patients had renal artery stenosis. CONCLUSIONS: Helical computed tomography is a suitable new non-invasive diagnostic modality for the detection of renal artery stenosis or adrenal pathology. With continued development and evaluation computed tomography could prove useful as a screening tool or as a replacement for digital angiography in patients with possible secondary hypertension.

Adolescent↗

PubMed2004

[Clinical implication of parameter-optimized 3D-FISP MR angiography (MRA) in children with aortic coarctation: comparison with catheter angiography].

PURPOSE: To implement parameter-optimized 3D-FISP MR angiography (MRA) with interleaved double-slab excitation and to compare the result with catheter angiography in children with aortic coarctation. MATERIALS AND METHODS: Eighteen children aged 2 - 15 years (mean 9.1 years) underwent MR imaging on a 1.5T body scanner (Magnetom Vision, Siemens, Germany). All patients had undergone correlative catheter angiography. T1-weighted turbo spin echo (TSE) images (TR 600 ms, TE 17 ms, flip 160 degrees, slice thickness 2 - 4 mm) were obtained in axial and parasagittal orientation, followed by an optimized 3D-FISP MR angiography in a sagittal plane (TR 12.5 ms, TE 5.5 ms, flip 22 degrees, matrix 256 x 256, slice thickness 1.25 mm). All children were sedated but on spontaneous breathing. Image quality was graded by two experienced reviewers using a 4-point scoring system. Source images and reformatted maximum intensity projections (MIP) were analyzed for blood-tissue contrast as well as size and focal stenoses of the aortic arch. RESULTS: Aortic coarctation was found in 13 of 18 patients, using the 3D-FISP MRA. A high correlation value (r = 0.96) was found compared to catheter angiography. Image quality was high in 94 % with well defined blood-tissue contrast in all cases. The sensitivity to flow and breathing motion was low. Examination time was about 15 minutes depending on volume of interest and heart rate. Diagnostic accuracy has shown improvement using a combined analysis of source and MIP images. The mentioned technique has provided an excellent display of thoracic vasculature. CONCLUSION: MR imaging represents an excellent tool for non-invasive examination of the cardiovascular system of children. The 3D-MRA allows the recording of a large 3D data set without the use of contrast agent and within an adequate measurement period, particularly in small infants unable to hold their breath. In addition, hemodynamic significance of aortic coarctation, the existence of collateral vessels and other congenital heart diseases can be described reliably by using this technique.

Adolescent↗

PubMedDate not supplied

Angiography and MR-angiography in the diagnosis of peripheral arterial occlusive disease in diabetic patients.

An invasive diagnostic procedure as angiography which involves direct arterial injection of contrast through suitable catheters, is still considered the gold standard in the evaluation of diabetic patients with peripheral arterial occlusive disease. The accuracy of anatomical details is combined on angiography with a pan view, indispensable for correct therapeutic planning. MR-angiography, with the 2D time of flight sequences in particular, supplies images of great anatomical accuracy and very sensitive in the detection of occlusive lesions which compare well with angiography and superior in the assessment of the length of occluded tracts. This noninvasive, cost-effective procedure seems bound to replace angiography in the pretreatment evaluation of diabetic patients with peripheral arterial occlusive disease.

Angiography↗

PubMed1998

[Can noninvasive gadolinium 3D MR subtraction angiography of visceral arteries replace conventional intra-arterial catheter angiography?].

Classic catheter angiography is compared with 3D gadolinium MR angiography for evaluation of the vascular anatomy of the celiac trunk, liver supplying arteries, and the portal venous system. Based on 10 patients, this study shows the value of this new non-invasive method of angiography for the diagnosis of visceral vascular anatomy. For this diagnosis MR angiography is expected to replace conventional angiography in the near future.

Angiography↗

PubMed1981

left ventricular segmental wall motion-a comparison between equilibrium radionuclide angiography and contrast angiography.

The qualitative assessement of left ventricular wall motion using a four-point scale has been compared between left ventricular contrast angiography and equilibrium radionuclide angiography in the 30 degrees right anterior oblique projection. Analysis was carried out for five segments of the left ventricle. Four modes of analysis of equilibrium radionuclide angiography were compared and the reproducibility assessed. Overall accuracy of equilibrium radionuclide angiography compared to contrast angiography was greater than 82% to within one degree of motion. One method using a cine display, averaged 97%. We suggest that equilibrium radionuclide angiography using the cine display is the non-invasive investigation of choice in the screening of patients with suspected regional wall motion abnormalities.

Adult↗

PubMedDate not supplied

Carotid plaque formation and its evaluation with angiography, ultrasound, and MR angiography.

The accurate assessment of carotid artery disease is an important challenge for magnetic resonance (MR) angiography. Studies indicate that the detection and grading of stenosis and the evaluation of plaque morphology are all important steps in the clinical assessment of atherosclerosis. The prevalence of significant carotid artery stenosis in the elderly population and even in patients with symptoms of carotid artery disease is low; clinical risk seems to correlate more closely with plaque morphology and surface characterization than with the degree of stenosis. This highlights the importance of MR angiography and ultrasound, which can help characterize plaque morphology in addition to showing the degree of stenosis. The authors review the present understanding of plaque formation, comparisons of plaque imaging with conventional angiography, ultrasound, and MR angiography, and recent progress in MR angiography techniques. Several studies, including the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial, are discussed regarding the current objectives of carotid artery imaging. The sensitivity and specificity of plaque detection and morphologic evaluation continue to improve.

Aged↗